Sex isn’t off-limits to people with osteoporosis. In fact, a healthy sex life can improve overall health by relieving stress, improving sleep, and releasing “feel-good” chemicals in your brain.

“Sex helps general health, well-being, mood, and immunity,” says Thom Lobe, MD, founder and medical director of the Beneveda Medical Group in Beverly Hills, Calif. But if you’re one of the more than 10 million Americans who live with weakened bones due to osteoporosis, you’ll want to take a few precautions in the bedroom.

Sex and Osteoporosis: Know Your Limitations

“Patients who are living with osteoporosis should be aware of their limitations prior to engaging in sexual activity,” says chiropractor Joseph Nguyen, owner and clinic director of the North Valley Wellness Center at Providence Holy Cross Medical Center in Mission Hills, Calif. “For example, if there are any areas of pain or weakness, particularly with the spine or joints, participants should be cautious and avoid certain positions that may cause pressure and lead to injury.”

One factor that plays a role in how you should have sex with osteoporosis is the severity of the condition. “What’s important is to understand the magnitude of the problem,” says Dr. Lobe. “Bone loss can be scored and ranges from a simple deficiency of bone, known as osteopenia, to severe mineral loss resulting in bone fragility and multiple fractures.” DEXA scans and other measurements of bone mineral density are used most often to determine the severity of the disease and the risk of fracturing a bone. Your doctor can discuss your test results and your fracture risk with you.

Sex and Osteoporosis: Sexual Positions

If you have osteoporosis, certain sexual positions may be safer than others. “The safest position is for the woman to be on top of the man,” says Mohammed Selim El-Dakkak, MD, an orthopedic surgeon at the Gramercy Surgery Center in New York. “Her body requires more positioning during sex, so it is good for her to be able to control what's comfortable for her.”

A woman with osteoporosis should avoid having sex with the man on top, says Dr. El-Dakkak. “It puts pressure on her hips. If she has osteoporosis, her hips are a very dangerous area on which to put pressure.”

Lobe suggests trying out different positions to find what is most comfortable for you. Consider using pillows or cushions for extra support. “Lying on one’s side, either facing each other or with the male partner facing his partner’s back, are the least strenuous sexual positions,” he says.

Remember that intimacy doesn’t always have to involve intercourse. Consider experimenting with other ways of giving each other pleasure that might be a little easier on the bones.

Sex and Osteoporosis: What to Talk About With Your Partner

The key to keeping sex safe and healthy when you have osteoporosis is a frank, honest discussion with your sexual partner. Nguyen suggests talking about your condition, the risks involved, and the positions you may want to stick to as a result.

“While it may seem awkward, it is important for your partner to know your limitations, and discussing safer positions can help you avoid injury,” Nguyen says. “Having an open discussion is the best way to ensure that the act remains enjoyable.”

Intimacy and sex are important elements of a relationship. Though you might have to make a few adjustments to stay safe, you don’t have to give up your sex life because of osteoporosis.